Benign emptying of the post-pneumonectomy space: A case report

Benign emptying of the post-pneumonectomy space (BEPS) is characterized by a decreased air-fluid level after pneumonectomy, albeit without the presence of bronchopleural fistula (BPF).

A 66-year-old man with lung cancer diagnosed clinical stage IIIA received right pneumonectomy. The air-fluid level of the right pleural cavity suddenly dropped on the 19th postoperative day. Although we were unable to detect the fistula of the bronchial stump using bronchoscopy, we performed re-operationt. Although a pressure of 30 cmH₂O was applied into the airway and air leakage from the bronchial stump was not detected, we covered the bronchial stump with the omentum. Because the air-fluid level of the right pleural cavity decreased 9 days after the 2nd operation without any symptom, we diagnosed the condition as BEPS.

If a fistula of the bronchial stump cannot be identified using bronchoscopy or thoracoscopy, then determining whether it is BEPS or microscopic BPF can be difficult.

It is currently unclear what the optimal strategy is in this case.